In the two years since the report was published, experts working in the space of women’s and maternal health say much has changed, but barriers persist. For people who experience menstrual cycles, it’s not only sometimes annoying or painful, but it can also be a costly and isolating experience. To combat costs and keep women and girls in school and employed, entrepreneurs, health workers, and advocates are sharing solutions to support women’s health.

Menstrual products include sanitary pads, tampons, menstrual cups and discs, and lined underwear. The National Organization for Women reported that a menstruating person spends about $20 monthly on period supplies.

When Christine Brown learned about periods and the costs associated with them, she thought it was ridiculously unfair.

“I thought, well, that sucks, and that’s not fair,” said the founder and owner of Kind Cup. “That sounds so expensive that girls and women are going to have to pay for these things.”

Brown has two patents for the Kind Cup, a sustainable menstrual cup with an ergonomic shape created with a minimal carbon footprint. The founder said she began to sketch potential products when she learned that some women might use up to 22 single-use products for each menstrual cycle.

“That’s expensive,” Brown told Direct Relief.

Across the United States, advocates have lobbied for more equitable policies regarding women’s health and to decrease expenses around what’s known as the “Pink Tax,” or additional costs associated with health products targeted toward women. Several states have adjusted Pink Tax laws to decrease how much women and girls must pay for supplies. Last year, Utah’s state legislature voted to support the availability of free period products in schools. This year, California’s state legislature voted to expand the use of federal funds to include period products for needy families.

But the Kind Cup founder said there’s never a “true sense of security” regarding women and menstrual health.

“I see, as a general trend, that we’re moving forward, but then there’s stuff that comes up where you’re like, Oh, I thought we were done with that, but here we go again, you know, there’s never a dull moment,” Brown said.

At the federal level, some healthcare policies have been adapted to allow people who have periods to use employer-driven HSA and FSA funds to purchase supplies.

Brown isn’t the first to design a menstrual cup. Dozens of other products are on the market, but the Kind Cup founder said she wanted to create a product with an improved design and user experience. Brown also recognized that materials matter, and no “fancy labeling and cut corners” would suffice. Brown said that the Kind Cup needed to be a high-quality device that people could trust.  

“You shouldn’t be in pain for having tried a bunch of different products and feeling like something’s wrong with your body,” said Brown. “No, it’s clearly indicative of there being a need for something that’s a better design.”

The Kind Cup has an added social benefit. Any purchase from Brown’s site prompts the buyer to donate a Kind Cup to another person. The first 150 Kind Cups were donated to other menstruating people.

Earlier this year, almost 100 Kind Cups were donated via Direct Relief to a Florida mobile health unit, one of dozens of organizations to receive the cups free of charge.

“We have a lot of uninsured people with barriers to getting health care,” said Michelle Nall, a nurse practitioner at the University of Florida’s Mobile Outreach Clinic.

The mobile unit is a program between the College of Medicine at the University of Florida and the university’s medical system. The mobile unit’s staff provides free, comprehensive, primary care for people without health insurance – largely those affected by factors including poverty, according to Nall.

The Kind Cups will be dispersed to patients and brick-and-mortar locations associated with the university’s health system and its partners, like local food pantries and churches. The mobile unit serves about 2,000 patients in North Central Florida, and Nall said that period poverty is common among their patients.

The nurse practitioner said that the need for reproductive justice remains pertinent as government policies shift, like the Supreme Court’s overturn of Roe v. Wade in 2022 allowed states to ban abortions, which restrict a person’s choice regarding personal health decisions, and the 2023 law signed by President Joe Biden that requires employers to provide reasonable accommodations for pregnant employees through the Pregnant Workers Fairness Act.

So, Nall focuses on what she can do to provide support for menstruating people in her community—whether they plan to have children or not.

Nall said it’s key to ask questions to gain a better understanding of what a patient needs to provide the appropriate support service.

Understanding the needs of menstruating people is a worldwide advocacy issue.

Diana Nelson, global advocacy director at Days for Girls International, said that in many countries, women who don’t have access to products are more likely to miss school and or work while menstruating. DFGI is a nonprofit that distributes sustainable menstrual health products around the world and participates in education and advocacy efforts regarding menstrual health.

To ensure worldwide understanding that menstruating is a natural process, Nelson said it’s key to include people who don’t menstruate in the conversation.

“It’s natural, it’s normal, it’s nothing to be ashamed of. It’s nothing to be scared of,” Nelson said. “So many girls wake up with blood, and they have zero idea what’s happened.”

Nelson said that DFGI works with volunteers and community leaders to educate people about menstruation cycles. That includes suggestions on creating supportive environments and sharing data about the impacts on women and girls who miss school or work while menstruating. Nelson said that in some places, menstruating people do not have a private bathroom and opt to go home in the middle of the day.

“If you want to increase education, then you need girls to stay in school… research shows they are missing school either because they don’t have access to products or because you don’t have the infrastructure where they can privately change,” Nelson said. “If you want your GDP to grow, if you want to create a labor market, you recognize that women are 50% of the laborers. And if they’re missing work because of their periods, or if they’re missing work because they have to leave to go find somewhere to manage their period….they don’t come back to work, and that is impacting your growth and your job market.”

Nelson also said good advocacy means helping the broader public understand how a singular issue impacts everyone.

To address period poverty, Direct Relief has provided period products, including Kind Cups, pads, tampons, Days for Girls kits, and more across the U.S. and globally.

The post Menstrual Health Experts Say Period Poverty Continues Across the Globe appeared first on Direct Relief.

In this episode of our podcast, we explore the realities of period poverty in the United States and the movement working to end it.

Transcript:

AMARICA RAFANELLI, HOST: You know those tampon dispensers in public bathrooms?

They’re like vending machines, except they give out tampons, not chips.

Insert a quarter, turn the knob. Period crisis averted.

But what if you don’t have a quarter? What if you don’t have money to buy tampons at all?

Women across America face this problem on a monthly basis. The price of period products forces women to choose between basic necessities.

JORIE NILSON: They spend their money on food because that’s the basic necessity. Any money they have goes to food.

That’s Nurse Practitioner Jorie Nilson. She’s the medical director at the Women’s Free Homeless Clinic in Santa Barbara.

NILSON: They lack food. That’s the big thing. They lack food. And they’re more concerned about food than just about anything.

RAFANELLI: OK. So if it comes down to it?

NILSON: They’ll buy food over hygiene products. That’s it for sure.

The women’s clinic happens three times a month in a transition home downtown. It’s a safe space where women can shower, eat a hot meal, and relax. In addition to offering basic medical care, the clinic provides women with free hygiene supplies—including pads.

RAFANELLI Why are you providing menstrual hygiene products for these women?

NILSON: Because it’s part of basic healthcare for a woman. And we’re trying to do everything that we can to provide the biological, psychological and social aspects of what every human being needs, but within our women’s clinic population.

RAFANELLI: I decided to go to the clinic to speak with some of the women. While I was there, I met Nancy. We talked about periods over a bowl of soup.

NANCY: I used to have go behind dumpster enclosures, go behind a tree and change real fast and hope nobody sees you. Stuff like that.

RAFANELLI: So you’d have to change your tampon or pad behind a dumpster?

NANCY: Yeah. I did it a lot. Go behind a dumpster enclosure and close the gate and change. I did that a lot. It was pretty commonplace.

RAFANELLI: Nancy was homeless for 23 years. She said when she was living on the streets, she couldn’t afford tampons or pads every month.

RAFANELLI: What would you did if you couldn’t purchase them?

Stick rags up in there. Maybe find an old shirt alongside a road and stick it up in there. I’ve done that.

RAFANELLI: Woah.

NANCY: Yeah, it’s rough out there. It’s rough out there sweetheart.

For Nancy, buying period products was just one worry on a list of many.

NANCY: Getting your stuff around in a shopping cart, I mean finding a safe dry place to sleep, yeah dealing with menstrual periods, if you got the flu, like, how you were going to recover and where you were going to sleep, staying warm, having enough blankets, having enough sweaters to stay warm at night. Yeah, it was a lot of things.

For women like Nancy, menstrual hygiene takes a backseat to buying food or finding shelter. When financial resources are stretched thin, tampons and pads are some of the first things to go.

But homeless women are not the only ones dealing with this problem. In Mississippi, immigrant women are up against the same struggle.

JOSE DELGADO: Following US Immigration and Enforcement Agency arrests that happened on August 7th where nearly 680 undocumented persons were taken into custody we realized that there were going to be a lot of persons, who unfortunately, were going to be in dire financial straits.

That’s Jose Delgado—the Vice President of patient services at Planned Parenthood Southeast. He helps manage the Planned Parenthood in Mississippi.

RAFANELLI: So were these women arrested and detained by ICE?

DELGADO: So most of the individuals, the 680 individuals who were detained, were mostly men. With that said, they had families and many of those were, not only their wives, if they did have wives, but their children are identifying as female. So, this was a big deal. We wanted to make sure that those individuals who previously had this financial resource that no longer existed were able to afford for some of the standard gynecological items that might help them with their day to day lives.

After the raid, Planned Parenthood requested menstrual hygiene products from Direct Relief. It was the first request of its kind. The Mississippi site had never provided their patients with tampons or pads before.

DELGADO: For our affiliate this is a first. It’s not that we didn’t think this product or being able to dispense these products were a necessity it’s more that it became more of a necessity with new obstacles. When you have individuals that are targeting particular families or persons things become a little bit more serious and particular families and persons are being targeted things become more serious and any help or support that these families can get becomes a little bit more of a priority.

RAFANELLI: In partnership with the nonprofit organization, Days for Girls, Direct Relief, sent Planned Parenthood 200 menstrual hygiene kits—each containing a reusable pad. Within 2 weeks, half of the kits had been distributed.

Without Planned Parenthood, these girls may have had to go without.

As menstruation becomes less taboo, more and more women are coming forward with their stories and attracting attention to the problem. In the first city-wide study of its kind, two-thirds of women in St. Louis, Missouri said they couldn’t afford period products at least once in the last year. More than 20% of these women said they experienced this problem on a monthly basis.

For activist, Jennifer Weiss-Wolf, these kinds of accounts are evidence of a national problem.

JENNIFER WEISS-WOLF: Anecdotally I would say there is almost overwhelming agreement that the ability to afford and manage menstruation is a challenge for people.

Weiss-Wolf has been hailed as a tampon crusader. She serves as vice president of development at the Brennan Center for Justice and is the co-founder of Period Equity—a non-profit that advocates for safe and affordable access to menstrual hygiene products.

WEISS-WOLF: This idea of period equity, it’s different than period poverty actually, and it’s not rooted in the experience of any one person, but the idea of equitable participation and engagement in civic life. Whether that is one’s education or workplace or any aspect of public life requires that we have a full understanding of menstruation. That we have the ability to manage menstruation. And I’ve taken up the issue with that perspective in mind. It’s surely about helping those that are most marginalized and most in need be able to manage menstruation fully, fairly, with dignity, and all of that. But it’s more, I think, actually driving towards that it’s a policy agenda and that it acknowledges that if half of the people that live by our laws have bodies that menstruate that acknowledging that within the framework of those laws is essential.

Period Equity is involved in several campaigns to pass policies that increase women’s access to period products. One of the organization’s main goals has been ending the tampon tax.

In 35 states, tampons, pads and menstrual cups are not exempt from sales tax. While other basic products, like toilet paper and soap, are also taxed by most states, activists argue taxing tampons—a product only half the population needs— is sex-based discrimination.

WEISS-WOLF: The tampon tax, sales tax, affects everybody. It wasn’t asking for any specific program or specific carve out, but to acknowledge that these products are a necessity and therefore deserving of this exemption. Slightly different questions if you can see what I’m getting at and it was a way to start that conversation.

In 2016, Weiss-Wolf led a class-action lawsuit to end the tampon tax in her home state of New York. The suit was successful in pressuring the governor to repeal the tax. But New York is an outlier. To date, only 5 states have passed a law ending the tampon tax.

WEISS-WOLF: The United States is just kind of scratching the surface right now. Kenya was the first nation to eliminate a national sales tax on menstrual products and did so in 2004. And has had policy ranging from menstrual product provision in schools to educational programs for the better half of the last decade.So yeah, I would say the United States is not ahead.

Thanks to activists like Weiss-Wolf, the United States is making incremental steps towards increasing women’s access to period products. This year, a bill that would make feminine hygiene products available for free in schools, shelters, and other public facilities was introduced into Congress. While other bills like it have been proposed in the past, the period equity movement has stimulated a national conversation that could give menstrual access laws unprecedented momentum.

WEISS-WOLF: Getting people to talk about menstruation, I would say, 500% improves their ability to be healthy in their menstruation. And that includes everything from helping to eradicate the shame, ensuring they are asking for what they need, in terms of information, in terms of medical support, in terms of product support. It’s a way to help live a healthier life and I don’t see why anyone would want to deny that.

RAFANELLI: While activists like Jennifer work to end the problem, women on the margins continue to deal with it on a regular basis. For many women, having a period without a tampon or pad to manage it is unimaginable. For women like Nancy, or the girls in Mississippi, it’s routine.

For Direct Relief, this is Amarica Rafanelli.

The post Rags Instead of Tampons. Here’s What Period Poverty Looks Like in the U.S. appeared first on Direct Relief.

She got slapped in the face by her teacher during a class.

Mwangi said she did not know what was happening to her body that day, and when her teacher asked her to come up to the front of the room to answer a question, she balked, out of embarrassment from the bleeding. He thought she was acting arrogantly.

“I hated, literally, being a girl, and I wanted to be a boy so badly,” Mwangi told Direct Relief about her feelings that day. She said she tried to stem the bleeding with plants, which led to infections, and pages from her schoolbooks, which led to more scolding from her teachers. Desperate to avoid being further shamed, she walked around a specific tree eight times, which a local legend said would turn her into a boy.

Mwangi’s first period came just three days before the Kenya’s pivotal national exam, which has a huge impact on student’s future educational prospects by determining which high school they will attend.

She failed it.

“Emotionally, I was traumatized, I could not even concentrate on the things I really know. Because all the time I was thinking, ‘Down there, I’m dirty. Everybody is going to laugh at me’,” Mwangi remembered thinking during the exam.

A Global Issue

Throughout the world, including within the United States, many girls and women struggle to obtain menstrual pads. A 2016 study of women with low incomes in St. Louis found that about two-thirds of those surveyed went without a feminine hygiene product at least once in the previous year because it was too expensive.

In other parts of the world, such as rural Kenya and Rwanda, the cost of a month’s supply of pads can equal a day’s pay, or even more, with a going rate of about $1 per package. Mwangi was one of 14 children in her family, so the thought of buying pads was out of the question, considering the family’s food needs and the fact that her father died when she was 13 years old.

The issue is also pressing from an economic loss perspective. A 2018 UNFPA report referenced various studies, including one that showed a “work loss of $1,692 annually per woman” in the U.S. because of menstruation. In Bangladesh, 73% of women miss work six days per month, but this figure is reduced to 3% if women were given pads, according to a UNFPA-cited report. In the Philippines, $13 million is lost and in Vietnam, $1.28 million is lost annually due to lack of access to feminine hygiene products, according to the World Bank.

American Celeste Mergens, CEO and founder of Days for Girls, witnessed these problems while working in Kenya in 2008. After an influx of children fleeing violence came to an orphanage she knew about, she began to wonder what the girls did during their periods. The answer, she learned, was that they waited in rooms on pieces of cardboard, for days.

Mergens would later learn that in parts of Nepal, girls and women are forced to sit in a hut or shed with animals, are restricted from using community water sources, and are oftentimes subject to very cold temperatures. Several deaths have been reported this year as a result of the practice, called chhaupadi, which is illegal but remains widely practiced in certain rural parts of the country.

In another tragedy, earlier this month, a 14-year-old girl in rural Kenya took her own life after being insulted by her teacher for being on her period.

Addressing cultural challenges around the issue would become central to Days for Girls’ approach, but Mergen first needed to get to work thinking about how to best design the products, and eventually settled on colorful, reusable kits. Just 11 years later, Days for Girls has managed to reach 1.5 million girls in 110 countries.

“I knew they needed something they could count on, month after month,” said Mergens.

The kits are handmade by some 60,000 volunteers around the world, as well as by enterprises throughout the developing world. Since 2015, the sewing group supporting Direct Relief has made about 3,500 menstrual cycle and postpartum kits, which have been used in 35 countries, including in the U.S. Direct Relief also transported an additional 1,745 kits to Lebanon in 2016 for Syrian refugees.

Mwangi, now a master’s student at Mount Kenya University in Nakuru, is one of the enterprise owners.

“It was a dream come true to learn about this organization,” Mwangi said. Her group has five women working to make kits and that she has been able to conduct educational seminars throughout Kenya as a result of her connection with Days for Girls.

“It helps girls from marginalized backgrounds to stay in school and away from cheap prostitution,” she said, noting that it is common for girls from low income families to do this so they can afford to buy pads. Mwangi’s group has reached 6,300 girls in just one year. It has also helped bring much needed income to her community, helping allow more children to stay in school, instead of going to work.

Working for Change

Distributing the kits, which are colorful to help hide stains and can last several years, have helped provide an opportunity to advance health education.

“This topic is not openly spoken about because of culture… menstruation is a taboo. But what is happening, slowly, is people are getting out of the status quo,” said Mwangi, who uses a powerful tactic to help open doors.

“I use my personal example and how that could have shattered my dream,” she said, adding that local leaders see, in her, an example of how successful girls can be if they are given opportunities to receive an education.

Days for Girls also runs courses for men, which Mergens said have been effective.

“If you include men in the conversation about menstruation that they are more likely to provide what’s needed for their family. They’re less likely to shame, they are less likely to isolate, and to mock,” she said.

The kits and education have catalyzed major changes in Kenya, and beyond. Mwangi pointed to two schools, in Mwigito and Ngongogeri, where girls have outperformed boys after receiving kits as well as reports that girls are missing fewer days at 90% of the schools that have received the kits.

“It’s giving them back dignity and hope and opportunity and letting them know they don’t have to be stopped by their basic biological functions,” Mergens said.

“There are so many things that are hard to change in our world, but this isn’t one of them. It just turns out that something this simple can change a woman’s life, and the way she sees her herself in relation to her community.”

The post Giving Girls Their Days Back appeared first on Direct Relief.

Direct Relief is working with Syrian Relief and Development, a group of doctors and nurses that have been working in Western Aleppo and Idlib Province. Idlib was the site of a devastating gas attack in April, and the appalling incident attests to the horrors of war and offers a grisly reminder to the world of the unceasing humanitarian crisis in Syria.

Direct Relief has provided Syrian Relief and Development with field medic packs, which contain an assortment of portable medicines.

Many local hospitals and clinics have been bombed and destroyed, forcing doctors and nurses to treat patients wherever they can. Emergency medical tents have also been sent by Direct Relief, and the tents allow a temporary space for triage care to take place.

Nearly 5 million people have fled Syria since the beginning of the country’s civil war nearly six years ago, a conflict the United Nations has called the largest humanitarian crisis of our time. Another 9 million are internally displaced, meaning they’ve remained in the country but have had to flee their homes.

Within Syria, healthcare access is nearly impossible for people who have been displaced from their homes.

Direct Relief has worked to secure a large donation of critical antibiotics that will help fortify healthcare operations in the country. Other essential items, like emergency health kits, have also been sent. The kits meet the global standard for emergency response and can treat up to 1,000 patients for 30 days. A partnership was forged between United Muslim Relief and Syria Relief and Development to distribute critical medicines and supplies in the country.

Many Syrians have fled to neighboring countries. Lebanon, Turkey and Jordan alone now host 4.7 million refugees, and the health needs of people in these countries are numerous. Below are some small snapshots of what Direct Relief has done in these countries to help.

Turkey is home to almost 3 million registered Syrian refugees. Direct Relief has been working with a public and private partnership between private humanitarian aid organization, ANSAGIAD, and AFAD, a Turkish authority. These public/private partnerships are critical to effectively delivering aid where it’s needed most, to Syrians living in formalized camps as well as millions of refugees living in urban areas near the Turkey/Syria border.

ANSAGIAD aids 17 hospitals serving approximately 1 million people, and Direct Relief has sent two large donations of medicine to ANSAGIAD valued at nearly $3 million. A third shipment is currently in process.

A Direct Relief emergency health kit has also been sent to the Syrian American Medical Society in Turkey, for their work with internally displaced people inside Syria.

Lebanon is hosting an estimated 1 million Syrian refugees, over 90 percent of which live outside of formal camps. That means that these refugees are more likely to seek care in community clinics and hospitals, placing a strain on that country’s healthcare safety net facilities.

Basic health services, like dental care, are also often lacking for refugee communities, and Direct Relief has committed $50,000 to humanitarian group ANERA Lebanon for a dental program in northern Lebanon focused on Syrian refugee children. Days for Girls feminine hygiene kits were also donated for refugee women in Lebanon.

Jordan hosts 655,000 Syrian refugees, with roughly 80 percent living outside formal camps. Non-communicable diseases, like diabetes and heart disease, remain leading causes of death for refugees. To deal with this, Direct Relief gave $300,000 to the Royal Health Awareness Society for their Healthy Community Clinics program, which focuses on treating non-communicable diseases.

Tobacco use is also common among refugees, and smoking cessation gum was donated to the Royal Health Awareness Society. Other key items to manage chronic conditions, like insulin, needles and syringes have arrived in Amman and are being distributed to charitable healthcare providers by the Jordan Ministry of Health. Key donations have also been made to the Jordan Health Aid Society as well as the Directorate Royal Medical Services.

Efforts to assist to Syrians in need will continue into 2017, and Direct Relief remains committed to the health of those within that country’s borders and beyond.

The post As Syrian Civil War Wages On, Direct Relief Aids Refugees in Country and Beyond appeared first on Direct Relief.

Isolation and feelings of uncleanliness, rooted in cultural beliefs and limited knowledge about periods, generate social stigmas and discourage women from seeking needed support. An additional lack of feminine hygiene products commonly forces girls to miss as many as two months of school each year, while disturbing the professional lives of women.

One organization with a mission to create a more dignified, humane, and sustainable world for girls is Days For Girls. Established in 2008, this organization is committed to supporting women in discovering their potential and value as agents of social change. Days For Girls encourages volunteers to sew sanitary kits for distribution to parts of the world where such resources are limited.

On Monday, Jan. 30, 2017, 18 volunteers gathered to assemble over 200 kits at Direct Relief’s Goleta warehouse.

Each kit consists of a drawstring bag, two-gallon Ziploc freezer bags, two moisture barrier shields, eight absorbent tri-fold pads, one washcloth, one travel-size soap, one instruction sheet and two pairs of girls’ panties. The kits are designed to be functional, long-lasting and geared to environments where disposable products aren’t practical. Vibrant, colorful patterns, thoughtfully sewn together, contribute to the discrete design of these reusable pads, which cater to areas where a female’s menstrual cycle is taboo.

Moving forward, these kits will be distributed to an existing network of partners supporting efforts to equip and empower women. Historically, these kits have been distributed to organizations in Peru, Haiti and countries in west and east Africa. With the intention of keeping girls in school longer, these groups have received assembled kits as a means of providing lasting feminine hygiene solutions.

To get involved, visit the Days For Girls website for instructions on how to make a hygiene kit.

The post How a Hand-Made Hygiene Kit Empowers Girls to Stay in School appeared first on Direct Relief.

Take Southall’s Sanitary Towels for Ladies, a solution for women to manage menstruation. The product hit the U.S. market in the late 1800’s. So why, more than a century later, do girls lose as
many as two months of school each year because of their periods?

The reason often amounts to a lack of appropriate hygiene products among students and insufficient sanitation resources at schools.

Here’s where Days For Girls comes in. With a mission to create a more dignified, humane, and sustainable world for girls, the organization encourages volunteers to sew sanitary kits for distribution to parts of the world where such items are in short supply.

Making Kits for Delivery

On Wednesday, Direct Relief enlisted a group of volunteers to assemble 115 kits.

In Haiti, the kits will help women who receive treatment for precancerous lesions through a Direct Relief-supported cervical cancer screening initiative. Such cases require cryotherapy, which freezes the precancerous cells. The healing process requires additional hygiene pads.

Because there is no municipal garbage disposal where these women live in Haiti, the kit’s reusability is among its essential qualities. Also, the kit’s colors and patterns are designed to mimic those of a hand towel or handkerchief, masking its purpose when hanging to dry.

Direct Relief will send additional kits to PazPeru, a Peruvian organization that helps women recover from sexual assault, and UNC Project-Malawi, which targets vulnerable adolescents who miss school because of lack of sanitary pads.

To get involved, visit the Days for Girls website for instructions to make a kit: DaysForGirls.org/whats-in-a-Kit?

The post In 2015, a Girl Shouldn’t Have to Miss School Because of Her Period. appeared first on Direct Relief.